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8/21/2019 Week 1 - Introduction to HWTS
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Introduction to the course
Introduction to Household Water Treatment and Safe Storage, Mo
Dr. Richard Johnston
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Course outline Quizzes and homewor
Course forum
Introduction
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Week 1
Background
Disease
Contamination
Week 2
Water Safety
Sedimentation
Filtration
Week 3
Disinfection
Safe storage
Week 4
Implementation
Strategies
Vulnerable groups
Outline
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In-video quizzes End of week quizzes
Peer-reviewed assignm
Final exam
Quizzes and Homework
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General discussion
Study groups
Lectures
Exercises
Course material errors
Technical issues
Online forums
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End of module
End of week
Summary
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Global Burden of Disease
Introduction to Household Water Treatment and Safe Storage, Mo
Dr. Richard Johnston
8/21/2019 Week 1 - Introduction to HWTS
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Diseases caused by u
and sanitation Water-borne
Water-washed
Water-based
Water-related
Global burden of disea Mortality
Morbidity
Introduction
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8.4 deaths/1,000 55 million people per year
19.9 births/1,000 135 million people per year
About 1.1% increase p Doubling every 60 years
Birth, taxes, and death
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Bradley Classification
Water-borne
Water-washed
Water-based
Water-related
Disease Classification System
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Water-borne diseases
Caused by ingestion
Diarrheal diseases Rotavirus
Cholera, Shigella
Cryptosporidiosis
Hepatitis A and EPolio
Improve water quality
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Water-washed diseases
Caused by poor hyg
lack of water
Most water-borne dise
Trachoma
Acute respiratory infec
Increase water quanti
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Water-based diseases
Caused by parasites
part of their life cycl
Schistosomiasis (bilha
Dracunculiasis (Guine
Target aquatic organis
Protect surface water
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Water-related diseases
Caused by insects w
in water
Malaria
Dengue fever
Remove habitat
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Many diseases are rel
water, sanitation, and h Water-borne diseases
by ingestion of contam
drinking-water
HWTS can reduce bur
borne diseases Not water-washed, water-ba
related diseases
Summary
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Mini-Quiz
Arrange the following five diseases in order of the number of dea
Tuberculosis
Diarrheal dis
Lower respiratory
infections
(e.g. pneumonia)
Mala
Measles
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Mini-Quiz
Source: WHO in 2013 published figures for 2011. Data files
Tuberculosis
Diarrheal disease
Lower respiratoryinfections
(e.g. pneumonia)
Malaria
Measles
976,000
1,894,000
3,203,000
589,000
167,000
http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.htmlhttp://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html8/21/2019 Week 1 - Introduction to HWTS
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1.9 million diarrheal de Most important water-borne
3.5% of all deaths 9.3% of under 5 child deaths
Second only to respira
among infectious disea
88% of diarrheal death
by inadequate water, shygiene 2011: Data not yet disag
2004: 1.9 million WASH
2.2 million diarrhea
Diarrheal disease
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Disability Adjusted
Life Years (DALYs)
DALY = YLL + YLD
YLL = Years of Life Lost
Number of deathsStandard
life expectancy at age of death in
years
YLD = Years Lived with Disability
Number of incident cases
Disability weightAverage
duration of the case (years)
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Diarrhea causes 52.5 3.1% of global total
9% of child disease burden
India 13.6 M
China 3.9 M
Nigeria 3.9 M
Pakistan 3.3 M DRC 3.3 M 10% of all DALYs
Diarrheal morbidity
Source:
G 20 0 S
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Global Burden of Disease 2010 Study (IHME)
GDB 2010 S d
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Similar approach to W
Not endorsed by WHO Methods not fully transparen
Lacked full access to results
Some key differences
numbers Revised disability weights
No hygiene risk factor
No disease burden from imp
sanitation
GDB 2010 Study
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http://www.healthmetricsandevaluation.org/g
GDB 2010 St d
http://www.healthmetricsandevaluation.org/gbdhttp://www.healthmetricsandevaluation.org/gbd8/21/2019 Week 1 - Introduction to HWTS
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1.5 million diarrheal de
89.5 million DALYs India 27 M
DRC 6.4 M
Nigeria 6.2 M
Pakistan 5.5 M
China 1.3 M
Only 25% diarrheal de
poor water and sanitat Water and sanitation: 0.9% o
Hygiene not included
GDB 2010 Study
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WHO calculations
2011: data and maps
1.9 million diarrheal deaths
52.5 million DALYs from diarrhea Disaggregated by disease and age
2004: data and maps
2.2 million diarrheal deaths
Disaggregated by disease, age, country, regio
IHME calculations
2010: data and maps
1.5 million diarrheal deaths
89.5 million DALYs from diarrhea
Burden of Disease
Summary
Conclusion
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Burden of disease from
is high
Diarrheal disease is a
of mortality and morbid
Different online resour
Next: Microbial Water
Conclusion
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Water-borne pathogens
Introduction to Household Water Treatment and Safe Storage, Mo
Dr. Richard Johnston
Introduction
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Different classes of pa
Helminths
Protozoa
Bacteria
Viruses
Introduction
Protozoa
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Protozoa
Bacteria
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E. coli Toxic forms
Shigella Vibrio cholera
Bacteria
Viruses
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Rotavirus
Hepatitis A and E
Polio
Viruses
Guinea worm
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Guinea worm
Credit: The Carter Center
Guinea worm
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Guinea worm
Credit: The Carter Center / L. Gubb
Guinea worm
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Guinea worm
Credit: The Carter Center / L. Gubb
Guinea worm
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Guinea worm
Credit: The Carter Center / E. Staub
Summary
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Summary
Helminths
Dracunuculiasis(Guinea worm)
Larvae in insect host
~1000 m
Protozoa
Cryptosporidium, Entamoeba, G
Can form resistant cysts
~10 m
Bacteria
E. coli, Shigella, Vibrio cholera
~1 m
Viruses
Rotavirus, Hepatitis A and E, po
~0.1 m
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How does Drinking Water become unsafe?
Introduction to Household Water Treatment and Safe Storage, Mo
Dr. Richard Johnston
Introduction
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Microbial safety Diarrheal disease
Faecal pathogens
Indicators of faecal con
F-diagram
Chemical safety
Introduction
The ideal faecal indicator should
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be universally present in faeces of human
in large numbers
be present in higher numbers than faecal
not be pathogenic
be readily detected by simple, inexpensive
persist in water in a similar manner to faec
not multiply in natural waters
respond to treatment in a similar fashion to
The ideal faecal indicator should
Common faecal indicators
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Total coliforms (TC)
Common faecal indicators
Total Coliform
Common faecal indicators
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Total coliforms (TC) Ferment lactose, producing acid and gas at 35 oC
Citrobacter, Klebsiella, Hafnia
Enterobacter
E. coli, Salmonella, Shigella, Yersinia
Not useful as faecal indicator Many non-faecal sources
Operational monitoring Effectiveness of treatment
Cleanliness and integrity of distribution system
Common faecal indicators
Total Coliform
Common faecal indicators
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Total coliforms (TC)
Thermotolerant coliforms (TTC)
Total Coliform
Thermotoleran
Coliforms
Common faecal indicators
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Total coliforms (TC)
Thermotolerant coliforms (TTC) Ferment lactose within 48 h at 44 oC
Previously: Faecal coliforms
106-109cells per gram faeces
Some indication of non-faecal TTC Klebsiella, some Enterobacter spp.
May grow or die off at ambient temperatureTotal Coliform
Thermotoleran
Coliforms
Common faecal indicators
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Total coliforms (TC)
Thermotolerant coliforms (TTC)
Escherichia coli (EC)
Total Coliform
Thermotoleran
Coliforms
E. coli
Common faecal indicators
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Total coliforms (TC)
Thermotolerant coliforms (TTC)
Escherichia coli (EC) Generally considered most suitable indicator
Some possibility of growth in environment Only moderately persistent, resistant
Total Coliform
Thermotoleran
Coliforms
E. coli
Relative risk
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Indicator count
per 100 mL
1000
Relative risk matrix
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0 1 2 3 4 5
E
D
C
B
A
No
Action
Low
Risk
Intermed
Risk
Sanitary Inspection
E.coli
level
Other faecal indicators
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Coliphage viruses Require bacteria for hosts
Faecal streptococci Lower numbers than colifo
More persistent, resistant
Bacterial spores Similar to protozoa
Highly persistent, resistant
Clostridium perfringens
Bacillus spp.
The F-Diagram
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Opportunities for contamination
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1Water Resource
2Delivery system
3Collection and Transpo
4 Household storage
5Consumption
Summary
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E. coli is the preferred
bacteria for faecal con
The F-Diagram shows
pathogens can be dist
environment, and be in
new host
Drinking water can bec
contaminated in a vari
along the water chain.
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What is HWTS?
Introduction to Household Water Treatment and Safe Storage, Mo
Dr. Richard Johnston
Introduction
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Household Water Trea Sedimentation
Filtration Disinfection
Safe Storage
Sedimentation
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Removal of suspended
turbidity
Gravity Settling
Coagulation Plant-based
Aluminium and iron salts
Filtration
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Water is passed throug
material Ceramic filters Synthetic membranes
Biological filters
Gravity or external pre
Particles removed
Challenge of fouling, c
Disinfection: heat
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Disinfection: ultraviolet radiation
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Disinfection: chlorine
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Safe storage
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To prevent recontamin
Small opening Possible to clean
Tap to dispense water
Summary
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Introduction to future p
Detailed explanations Efficiency against different c
pathogens
Advantages
Challenges
No one process is the
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HWTS and the MDGs
Introduction to Household Water Treatment and Safe Storage, Mo
Dr. Richard Johnston
Introduction
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What are the Millenniu
Development Goals?
How does HWTS fit int
The Millennium Development Goals
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1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower wome4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
The Millennium Development Goals
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1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower wome4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
Target 7C: To halve, by 2015, the proportion of
sustainable access to safe drinking water a
sanitation.
Sustainable access to safe water
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HWTS can contribute t
access to safe water
Short- or medium-term meas
MDG 7 needs quantity
HWTS contributes to o
MDG 4: reduce child mortali
MDG 6: combat HIV/AIDS, mdiseases
MDG 1: links with malnutritio
MDG 2: links with education
Summary
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HWTS contributes to t
target for safe water
And other targets
Not an indicator in its o
Doesnt equal sustainable a
water
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International Network on Household Water
Treatment and Safe Storage (The Network)
A platform for researchers, practitioners and policy makers in HWT
Michael Forson, (co-host of the Network)
WASH Specialist (Water Supply and quality)
UNICEF, New York
Th i Wh t t i d th
Outline
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The issueWhat triggered the ne
Why a network?
The Network strategy
Network mission Network objectives
Network Targets
Hosting and implementation arran
Membership and Benefits of parti
Key Achievements
Challengeswhat worked (is wodid not
Way forward
Participation and benefits
A large part of the worlds population is without access to drinking w
The Issue . What triggered the Network?
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A large part of the worlds population is without access to drinking-w
improved sources (768 million; 2011); several billion more, without a
drinking-water.
Millions, often in urban areas, served by unreliable piped systems ar
drinking-water with significant risks of contamination.
Millions are affected by emergency situations where water, sanitatio
services may have broken down partially or completely, posing risk t
the drinking water.
Diarrhoeal death major cause of child mortality; safe drinking-wate
prevention intervention
Stanford University/AmyPickering
Why a Network?
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WHO convened a multi-stakeholder meeting
in Feb 2003 to identify a platform that will
cover all stakeholders to address the issuesidentified, and a network was deemed the
best forum to be used in this case
Why a Network? The advantages
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A network is a forum, information
clearinghouse and vehicle to
promote collective, bilateral and
individual action on the part of its
stakeholders
A network encourages
communication, cooperation and
coordinated action while optimizing
flexibility, participation and
creativity.
As a network we canMonitor and map global effo
advocacy, implementation aRaise awareness about the
with one understanding and
governments in decision ma
Conduct agreed targeted an
research to increase effectiv
=> health gains (impacts)
Maximize collective gains in
on individual gains
How things evolved down the timeline .
East African
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Strategic
consultations
PHAPHASE 1
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
WHO conceived
the idea to
facilitated a forumfor promotion of
HWTS based on
health gains
Multi-
stakeholder
consultative
meeting in
Feb 2003
7-point strategy
for comprehensive
diarrhoea control
adopted by WHO
and UNICEF. HWTS
is mentioned as a
key intervention
Letters of exchange
to co-host the
Network was signed
between UNICEF and
WHO
HW
wo
Na
exbe
West
Regio
work
Accra
South African
Regional HWTS
Workshop Held
in Mozambique
East African
Regional
HWTS
Workshop
Held in
Uganda
Plenary Meeting
Nairobi, Kenya
June 2004.
1st5 year strategic
plan (2003 2008)
developed.
Strategic
consultation in
Geneva proposingco-hosting with
UNICEF
HWTS Network Global Strategy 2011 - 2016
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To contribute to a signifi
reduction in water-borne
related vector-borne disespecially among vulner
populations, by promotin
water treatment and saf
a key component of com
targeted environmental
programmes.
Mission statement
Obj ti T t
HWTS Network Global Strategy 2011 - 2016
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Objectives HWTS evidence base of public health
relevance significantly strengthened
Tangible results in the scaling-up ofhousehold water treatment and safe
storage achieved globally
National policies and institutional
frameworks developed (=> integration of
environmental health interventions) Best practice in HWTS programmes
evaluated and disseminated for
advocacy purposes
Targets By 2015, 30 countries ha
policies on household w
and storage. By 2015, strengthened
guide effective and replic
programmatic approache
long-term widespread us
health impact. By 2020, 50 countries h
country-wide scale up of
HWTS.
Currently over 160 membership
Participation and benefits
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Currently over 160 membership
Connect with a global Network of HWTS ex
senior officials, programme implementers,
on-the-ground practitioners
Receive the latest news on HWTS projectsevents through the Network listserv and ne
Find out who is active where and engage w
have faced similar challenges
Have your work disseminated and highligh
communications material
Have a voice in the annual network meetinhave input to the annual work plan
Have access to an online, interactive webs
and discuss matters of interest with Netwo
Responsibilities within the secretariat
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WHO
Knowledge Advancement Research
Knowledge Management
Technology assessment
Policy and Advocacy
Global and National level
advocacy Policy formulation and review
UNICEF
Capacity Developme Training workshops
dissemination of best
etc
Monitoring
Global progress in HW
Mapping country levimplementations
UNC
Maintain Regular and
constant communication
within the secretariat
Key Achievements
Hosted over half dozen regional workshops
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Hosted over half-dozen regional workshops
leading to the formation of over 20 national HWTS
action plans
Developed toolkit and harmonized indicators tostrengthen monitoring and implementation
Raised awareness for integration among key
public health efforts (HIV/AIDS, maternal/child
health, nutrition) on role of HWTS
Supporting quality assurance through the HWTSevaluation scheme
Global capacity building through strategic webinars
What worked (is working)
What worked (is working) and on-going challenges
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What worked (is working) Co-hosting arrangement harnessed the strengths of
both organizations
Regional workshops (focused, controlled) Integration with other environmental health projects
On-going challenges Working groupsstarted well, but died off. Like a
community of practice
Ambitious budget
Need clear alignment and harmonization between WaterSafety Plans and HWTS
Advisory groupwas working great, however faced with
challenges of participation
HWTS Network webpage:
More information and links
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HWTS Network webpage:
http://www.who.int/household_water/network/en/
HWTS Network communications portal
http://waterinstitute.unc.edu/hwts
http://www.who.int/household_water/network/en/http://waterinstitute.unc.edu/hwtshttp://waterinstitute.unc.edu/hwtshttp://waterinstitute.unc.edu/hwtshttp://www.who.int/household_water/network/en/http://www.who.int/household_water/network/en/8/21/2019 Week 1 - Introduction to HWTS
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Week 1 Summary
Introduction to Household Water Treatment and Safe Storage, Mo
Dr. Richard Johnston
Week 1 Summary
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Global Burden of Disea
Disease classification system
Morbidity (DALYs) and mortadisease
Estimates from WHO and IH
Water-borne pathogen
Helminths, protozoa, bacteri
Week 1 Summary
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Contamination pathwa
F-diagram
Faecal indicator bacteria
First glance at treatme
Sedimentation
Filtration
Disinfection (heat, ultraviolet
Safe storage
Week 1 Summary
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HWTS and the MDGs
The HWTS Network